P1711: LOCKDOWNS AND CANCER DIAGNOSIS: IMPACT OF COVID19 PANDEMIC ON NEW HAEM-ONC PRESENTATIONS
Authors: D. Discalicau, P. Greaves
Journal: HemaSphere (2022)

Background: National lockdowns of various stringency were adopted to reduce spread of COVID19 through 2020/2021. The effect of lockdowns and changed social behaviour impacted presentation to healthcare for all conditions, particularly new cancers, with potential harm through late or non-presentation. The UK adopted its most stringent lockdowns affecting London between March and June 2020, and December 2020 and April 2021. Patients urgently referred by GP for suspected cancer fell by 50% nationally during the first lockdown. The effect of reduced cancer presentation requires further examination to assist harm/benefit analysis of future lockdown strategies. Aims: Examine the effect of the pandemic and lockdowns on new haem-onc diagnoses at a hospital in Greater London, UK, serving an ethnically and socioeconomically diverse population of around 850,000. Methods: All new adult haem-onc diagnoses captured through an integrated electronic database at the hospital were reviewed. Years were defined as financial rather than calendar years (starting 1st April) both conventionally and since this coincided approximately with lockdowns allowing easy comparison with preceding years. Results: The department recorded a mean of 346 (SD 14.6) haem-onc diagnoses per year between 2015/16 and 2019/20. In 2020/21 only 272 diagnoses were recorded – 21% below average or 5 SD below the mean. In the pre-pandemic 5 years, average quarterly diagnoses Q1&Q2 (Spring/Summer) were significantly lower than Q3&4 (Autumn/Winter) at 81 vs 92 per quarter (p=0.01). During 1st lockdown only 58 diagnoses were captured (Q1 2020/21 – 72% of the Spring/Summer average). During 2nd lockdown only 68 diagnoses were captured (Q4 2020/21 – 74% of the Autumn/Winter average). During Q2 2020/21 when lockdowns eased, there were markedly reduced numbers of COVID cases and deaths, but an ongoing reduction in new cancer diagnoses (81% Spring/Summer average). During Q3 of 2020/21 when lockdowns were only regional and partial, but COVID case and deaths were increasing, new diagnoses approached normal levels (87% Autumn/Winter average). During the first 3 quarters of 2021/22, new diagnoses had returned to pre-pandemic levels. Impact on haem-onc cancers detected through blood tests (paraprotein and leukaemias) appeared more marked than those presenting as symptomatic (lump/pain/bleeding, etc) tumours – i.e. lymphoma. During both lockdowns 35% fewer blood test detected diagnoses (defined as leukaemia or paraprotein) were captured (35 vs 55 per quarter). Between lockdowns there was only a 6% reduction. In contrast there was no reduction in new lymphoma diagnoses during or between lockdowns compared to 5 preceding years’ average (25 per quarter on average) Summary/Conclusion: The COVID pandemic led to around 1/4 reduction in new haem-onc diagnosis with the most significant impact occurring during times of national lockdown. Causes will be complex and multifactorial including fear of healthcare environments and public places in general, loss of normal hospital and primary care services and death and illness from COVID prior to reaching healthcare. However, the impact seemed to be predominantly in diagnoses picked up on blood tests, rather than symptomatic ‘lumps’ and we might hypothesize that lymphomas, presenting conspicuously and symptomatically trigger patient and healthcare provider behaviour that allows access to diagnosis, and is less likely to be ignored or missed. The impact of missed and late cancer diagnoses on survival and excess deaths continues to be explored as an essential investigation into impact of both pandemic and public health responses.